Parenchymal Fibrosis and Cancer Specific Outcomes Following Liver

1
Parenchymal Fibrosis and Cancer Specific Outcomes
Following Liver Resection in Patients with HBV
Associated Hepatocellular Carcinoma Hiotis SP1,
Manizate F1, Fiel MI2, Labow DM1, Roayaie S1, and
Schwartz ME1 Depts. of Surgery1 and Pathology2,
Mount Sinai School of Medicine, New York, NY
Introduction Unlike most risk factors for HCC,
chronic HBV is often associated with cancers
occurring in the absence of cirrhosis. This
observation suggests a dual pathway to
hepatocarcinogenesis in patients with HBV one
preceded by severe chronic inflammatory events
and cirrhosis, and an alternate
cirrhosis-independent pathway. The purpose of
this investigation is to determine whether
differences in oncologic behavior are exhibited
by cirrhosis-associated vs. cirrhosis-independent
HBV-HCC. Methods Patients with HCC treated at
Mount Sinai Hospital (New York, NY) between the
years of 1988 and 2008 were entered into a
prospective clinical research database. An
analysis was performed on those patients with
HBV-HCC treated with liver resection, and an
objective assessment of parenchymal fibrosis
(Histologic Acitivity Index, HAI) was recorded.
Cancer-specific outcomes including survival and
cancer recurrence were determined via
Kaplan-Meier analysis and compared via log rank
test.
Results Among 2830 total patients treated for
HCC during the study period, 684 assessable cases
were attributed to chronic HBV and 241 (35) of
HBV-HCC cases were treated with liver resection.
Cirrhosis (stage 4 fibrosis) was established at
the time of initial cancer diagnosis in 134/241
(56) HBV-HCC patients, with normal parenchyma
(36/241, 15) or less severe fibrosis (stage 1-3
fibrosis 71/241, 29) in the remaining HBV-HCC
patients. Oncologic outcomes were least favorable
in patients with cirrhosis, while patients with
normal or fibrotic liver parenchyma had more
favorable overall survival and cancer recurrence
rates. (Table 1) Conclusions Patients with
HBV-HCC treated with liver resection demonstrate
better cancer-specific outcomes when diagnosed
with cancer in the absence of cirrhosis. These
data suggest that cancers occurring in the
absence of cirrhosis or severe chronic
inflammatory events demonstrate more favorable
biologic behavior. Prevention of progression to
cirrhosis may improve chronic HBV-associated
outcomes, both in terms of liver function and
cancer prognosis.